Hepatitis A increase shows need to know A, B, C of hepatitis

Monday

Polk County isn’t immune from the dramatic statewide increase in cases of hepatitis A, a liver-attacking, infectious virus spread through feces of people who are infected.

This county’s 30 cases from Jan. 1, 2018, through May 11, 2019, may seem small beside the 292 in neighboring Pasco County and 176 in Hillsborough.

Yet Polk had one of 18 deaths reported in Florida as of May 4, said Dr. Joy Jackson, director of the Florida Department of Health in Polk. The 30 cases in that period also were more than Polk’s total from 2010 through 2017.

In response, local Health Department teams have shifted their main focus from two “completely different” hepatitis viruses – B and C – to a concerted effort to find, educate and vaccinate people at higher risk of hepatitis A.

The health department vaccinated 1,877 local residents in the first four months of this year, said Greg Danyluk, its epidemiology manager.

Their primary outreach targets included jail inmates and people who are homeless or in unsecure living situations.

Not that hepatitis B and hepatitis C aren’t ongoing concerns, he said, but the immediacy of the hepatitis A increase needed prompt attention.

Even in minimal amounts, infected feces can spread hepatitis A through food, objects, drinks and drugs (whether injected or taken other ways).

People at higher risk of getting hepatitis include drug users, men who have sex with men, people who travel to countries where hepatitis A is common, household members or caregivers of recent adoptees from countries where it’s common and people with clotting factor disorders such as hemophilia.

Being in direct contact with someone who has hepatitis A also raises risk.

People with hepatitis A typically don’t start feeling sick for a couple of weeks. An infected person may not look sick.

“Children are frequently asymptomatic,” Danyluk said.

Symptoms appear between 15 and 50 days after infection and can include yellow eyes or skin, abdominal pain or pale stools.

Hand-washing and getting vaccinated are the two chief ways to reduce risk.

“The general public needs to be conscious of good hand hygiene and hand-washing,” Jackson said.

Follow guidelines for getting vaccinated against hepatitis A, either as prevention or as immediate treatment after possible infection.

DOH recommends hepatitis A vaccine for all children at age 1, illegal drug users, people experiencing homelessness and men who have sex with men.

Hepatitis A vaccine as treatment is most commonly given as a safeguard within a few days of possible infection, Jackson said. Some people may get immunoglobulin instead.

Drug use is the most common factor statewide in hepatitis A cases identified since Jan. 1, 2018. Nationwide, the opioid epidemic is a major factor in increased hepatitis A, Danyluk said.

In Florida, 276 cases were reported in 2017 and 548 in 2018. There were another 1,129 this year, through May 11, more than in 2017 and 2018 combined.

The last time Polk had a major hepatitis A scare was in 2002, when panic about one infected worker at the former John’s Restaurant in Bartow led to its closing.

In a strangely similar case, controversy erupted in Hillsborough this year over disagreement involving a health worker at a restaurant that since has closed.

Fortunately, restaurant exposure is extremely rare, Danyluk said.

National outbreaks

What about hepatitis B and hepatitis C?

They’re different viruses, held together by the term hepatitis, which denotes liver inflammation.

There’s overlap, however. One-fourth of people with hepatitis A in Florida are co-infected with hepatitis B or hepatitis C.

Hepatitis C is getting more attention than hepatitis B for a couple of reasons.

One is its prevalence among people born 1945-1965. Health officials for years, with mixed success, have urged people in that age group to be tested.

Another is a federal judge’s ruling in April that prison officials were “deliberately indifferent” in treating inmates in Florida who have hepatitis C. The ruling expanded the number of inmates who should get treated for the disease, which can be cured.

Most people who get hepatitis C now are infected by sharing needles or other drug-injecting equipment. Before 1992, it also was spread more regularly through blood transfusions and organ transplants.

Unlike hepatitis A and hepatitis B, there’s no vaccine for hepatitis C. An estimated 2.4 million in the U.S. were living with hepatitis C in 2016.

Hepatitis B virus spreads when blood, semen or other body fluid from someone infected with hepatitis B gets into the body of someone who isn’t infected.

Guard against it by getting the hepatitis B vaccine.

Needle sticks are a common method of transmission, as is direct contact with blood or open sores of someone who’s infected. Sex with an infected person or sharing items like razors that could contain blood are others.

Health workers, hemodialysis patients and babies born to infected women are at higher risk.

Hepatitis B isn’t spread routinely by food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing or sneezing, according to the federal Centers for Disease Control and Prevention.

Robin Williams Adams can be reached at robinwadams99@yahoo.com.

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